Journal of Dairy, Veterinary & Animal Research

Case Report Open Access New therapeutic protocol for canine babesiosis: a case report

Abstract Volume 3 Issue 3 - 2016 Canine babesiosis is typically characterized by hemolyticanemia, thrombocytopenia, Nandini MK,1 Poonam Vishwakarma,2 Ansar fever, and splenomegaly. A male Labrador aged three years eight months was presented 3 to the veterinary clinic with a history of brownish urination, anorexia and lethargy since Kamran C 1The Companion Animal Clinic, India one week. Clinical examination revealed high temperature (105.70F), pale mucous 2Biosafety Support Unit, India membrane and splenomegaly. Haematology revealed anaemia and thrombocytopenia 3Department of Teaching Veterinary Clinical Complex, Hasan (Hb- 7.7g/dl; Platelet count- 86,000/µl). B. Gibsoni (+++) was evidenced in blood Veterinary College, India smear. Treatment was initiated with a combination therapy of Clindamycin @ 25mg/ kg PO q 12h, Metronidazole @ 15mg/kg PO q 12h and Doxycycline @ 5mg/kg Correspondence: Poonam Vishwakarma, Scientist, Biosafety PO q 12h for 10days. There was no adverse reactions and the dog showed clinical Support Unit, Regional Centre for Biotechnology, Government and haematological improvement from 4th day of treatment onwards and recovered of India, New Delhi, India, Tel 011 2465 4007, uneventfully by the end of therapeutic protocol. Email [email protected]

Keywords: B. gibsoni, canine, clindamycin, metronidazole, doxycycline, Received: May 17, 2016 | Published: June 06, 2016 combination therapy, haematology, biochemistry

Abbreviations: Hb, haemoglobin; TLC, total leucocyte count: Table 1 Haematological and Biochemical findings in affected dog SGOT, serum glutamic oxaloacetic transaminase; SGPT, serum gluta- mic-pyruvic transaminase; ALP, alkaline phosphatase; @, at sign; SC, Parameters Day 1 Day 4 Day 7 subcutaneous; IM, intramuscular Hb(g/dl) 7.7 8.5 10.1 Introduction Platelet count(lakhs/µl) 0.86 0.88 1.2 TLC(103/µl) 18.3 16.2 16.3 Babesiosis is an important disease of domestic dogs and has been attributed to infection with either Babesia canis or B. Gibsoni, based Neutrophils(%) 66 63 60 on parasite size and the geographic location in which the infection was Eosinophils(%) 11 8 14 acquired. It is diagnostically important to determine the species that Lymphocytes(%) 22 29 25 causes canine babesiosis, since the virulence, prognosis, and response to anti babesial drugs may be different for each organism.1 Babesia Monocytes(%) 1 - 1 2 gibsoni was first recognized in India in 1910. There are at least three Creatinine(mg/dl) 0.9 - 1.3 distinct isolates of B. Gibsoni that are morphologically identical: one from Asia, one from California, and a third from Europe. The SGOT(IU/L) 49 - 49 Asian isolate is the original organism found in India and is considered SGPT(IU/L) 23 - 45 Babesia gibsoni sensustricto.3 ALP(IU/L) 120 - 352 Case presentation Total bilirubin(mg/dl) 1.8 1.8 0.6 A male Labrador aged three years eight months was presented Direct bilirubin(mg/dl) 0.8 0.9 0.2 with a history of brownish urination, anorexia and lethargy since Total protein(g/dl) 6.6 - 7 one week. Clinical examination revealed high temperature (105.70F), pale mucous membrane and spleenomegaly. Blood was collected and Albumin(g/dl) 2.4 - 2.6 subjected to routine hematology and biochemistry. Peripheral smear Globulin(g/dl) 4.2 - 4.4 study revealed presence of B. Gibsoni (+++) in the RBCs. Based Albumin: Globulin ratio 0.57:1 - 0.59:1 on clinical signs, hematological and biochemical report case was suspected for Babesiosis and blood smear confirmed it as B. Gibsoni Discussion infection. Conventional therapy for canine Babesiosis includes 2 doses of The animal was treated with Clindamycin @ 25mg/kg PO q 12h, Inj. Imidocarbdipropionate @ 5mg/kg SC or IM 2weeks apart. It Metronidazole @ 15mg/kg PO q 12h and Doxycycline @ 5mg/kg PO reduces morbidity and mortality but ineffective for clearance of B. q 12h for 10days and was advised for follow up after 3days. On fourth Gibsoni. Other drug used to treat Babesiosis is single injection of 0 day of treatment temperature was normal (101.8 F), parasitemia Diminazeneaceturate @ 3.5mg/kg SC or IM, but this is potentially was reduced to less than 10%, there was clinical and hematological dangerous and shows a propensity to develop severe cerebral toxicity improvement. Owner was further advised to come after four days for with classic cerebellar sulci haemorrhages. Moreover, B. Gibsoni are blood test (Table 1).

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very difficult to clear with such conventional therapy and dogs usually References become chronic carriers or present with recurrent episodes of acute babesiosis.4 1. Birkenheuer AJ, Levy MG, Breitschwerdt EB. Development and Evaluation of a Seminested PCR for Detection and Differentiation of The first treatment that has been shown to be effective against Babesia gibsoni (Asian Genotype) and B. canis DNA in Canine Blood B. Gibsoni is a combination of atovaquone and azithromycin.5 Samples. J Clin Microbiol. 2003;41(9):4172‒4177. Unfortunately Atovaquone is not available in India and it’s expensive 2. Patton WS. Preliminary report on a new piroplasm (Piroplasmagibsoni for import. Moreover Possible Emergence of Drug-Resistant sp. nov.) found in the blood of the hounds of the Madras Hunt and Variants of B. Gibsoni in clinical cases treated with Atovaquone and subsequently discovered in the blood of the jackal Canisaureus. Bull Soc Azithromycin has also been reported.6 Pathol Exot. 1910;3:274‒280. In the present case, combination of Clindamycin, Metronidazole 3. Trapp SM, Messick JB, Vidotto O,et al. Babesia gibsoni genotype Asia and Doxycycline gradually reduced parasitemia levels and in dogs from Brazil. Vet Parasitol. 2006;141(1‒2):177‒180. Clindamycin treatment reduced the clinical symptoms characteristic 4. Schoeman JP. Canine babesiosis. Onderstepoort J Vet Res. of Babesia infection, including anemia, anorexia, and listlessness 2009;76(1):59‒66. also subsided. The effectiveness of clindamycin for treatment of B. 7,8 5. Birkenheuer AJ, Levy MG, Breitschwerdt EB. Efficacy of Gibsoni infection has also been reported by several workers. But it’s combined atovaquone and azithromycin for therapy of chronic been suggested that clindamycin might not eliminate parasites rapidly Babesiagibsoni (Asian genotype) infections in dogs. J Vet Intern Med. from the peripheral blood but damages it which might stimulate 2004;18(4):494‒498. humoral and cellular immunity against Babesia infection and results 6. Sakuma M, Setoguchi A, Endo Y. Possible Emergence of Drug-Resistant in improvement in clinical condition.9 So, a Combination therapy Variants of Babesiagibsoni in Clinical Cases Treated with Atovaquone of clindamycin (CLDM), metronidazole (MNZ), and doxycycline and Azithromycin. J Vet Intern Med. 2009;23(3):493‒498. (DOXY) as an efficacious alternative treatment strategy forB. Gibsoni infection with no adverse effects has been suggested.10 7. Wulansari R, Wijaya A, Ano H, et al. Clindamycin in the Treatment of Babesia gibsoni Infections in Dogs. J Am Anim Hosp Assoc. Thus, present clinical case concluded that a combination therapy 2003;39(6):558‒562 of Clindamycin @ 25mg/kg, Metronidazole @ 15mg/kg and 8. Stegeman JR, Birkenheuer AJ, Kruger JM, et al. Transfusion-associated Doxycycline @ 5mg/kg for 10days is effective against B. Gibsoni Babesia gibsoni infection in a dog. American Journal of Veterinary with no adverse reactions and the dog showed uneventful recovery. Research. 2003;222(7):959‒963. Acknowledgements 9. Wulansari R, Wijaya A, Ano H, et al. Lymphocyte subset and specific IgG antibody levels in Clindamycin treated and untreated None. dogs experimentally infected with Babesia gibsoni. J Vet Med Sci. 2003;65(5):579‒584. Conflict of interest 10. Suzuki K, Wakabayashi H, Takahashi M, et al. A possible treatment Author declares that there is no conflict of interest. strategy and clinical factors to estimate the treatment response in Babesia gibsoni infection. J Vet Med Sci. 2007;69(5):563‒568.

Citation: Nandini MK, Vishwakarma P, Kamran CA. New therapeutic protocol for canine babesiosis: a case report. J Dairy Vet Anim Res. 2016;3(3):112‒113. DOI: 10.15406/jdvar.2016.03.00082